Talking to patients and families regarding initiation of dialysis can be complex. Typically shared decision making is recommended. This involves more than simply asking if the patient “wants” dialysis. There are two settings where this counseling is necessary. Each has different questions and concerns. The first is a patient with chronic kidney disease
What are the indications for Renal Replacement Therapy (RRT) with dialysis in Acute Kidney Injury (AKI)? The common indications: Uremia Life threatening volume overload refractory to medical treatment Life threatening hyperkalemia refractory to medical treatment Life threatening metabolic acidosis refractory to medical treatment Life threatening intoxication with a dialyzable drug This leaves the
Kidney cysts are commonly found on imaging and are a common cause of anxiety for patients. This overview will provide context with the aim of being able to minimize patient anxiety, avoid unnecessary referrals and triage patients for appropriate referral to nephrology or urology. The main question to ask yourself when a kidney
There are certain dermatologic conditions unique to ESRD that the nephrology practitioner should be aware of. These include: Uremic pruritus Calciphylaxis - calcific uremic arteriolopathy Perforating Dermatosis - Kyrle Disease Nephrogenic Systemic Fibrosis Uremic Pruritus Pruritus is a common complaint in ESRD. It may be localized or generalized. Pathogenesis. It is often attributed
When writing this article I felt a need to add more and more information, to be comprehensive. I had a fear of leaving something out. I need to stop. The intention of BCNephro is not to be an encyclopedic nephrology resource. The intention is to share my experiences in a way that makes
What is glomerulonephritis? Glomerulonephritis is inflammation of the glomerulus. This is may be manifest by: Clinical Findings: Glomerular hematuria Variable proteinuria (typically sub nephrotic may be nephrotic) Leukocyturia (variable) Impaired kidney function (variable) Hypertension (variable) May be renal limited or associated with systemic inflammation (vasculitis) Pathologic Findings: Glomerular hypercellularity Crescents (indicate more severe
Hypernatremia like hyponatremia is all about water. Hyponatremia indicates intracellular water excess (overhydration). Hypernatremia means the opposite, too little water. (At least too little water relative to sodium). This is dehydration. It indicates intracellular dehydration. This article will address: Pathophysiology Approach to Diagnosis Renal Causes of Hypernatremia Diagnostic Algorithm Treatment Pathophysiology What happens
Hypertension is a prevalent issue in dialysis patients. Mechanisms of Hypertension in ESRD patients Sodium and Volume Overload Sympathetic Overactivity Renin Angiotensin System Activation Sodium and Volume Overload The cornerstone of blood pressure control is volume management. In non ESRD patients with hypertension (HTN), sodium/ volume overload is a reason for an inability
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Amyloidosis is another relatively common systemic condition that causes nephrotic syndrome with unique kidney pathology. Approximately 2% of native kidney biopsies will show amyloidosis. What is amyloidosis? Amyloidosis is a syndrome where proteins deposit in tissues in a specific misfolded pattern forming what is called beta pleated sheets. These protein deposits result in
